Cardiovascular Surgery Aortic Valve replacement

Aortic Valve Replacement (AVR)

Objective

•   To open chest 

•   To expose the heart 

•   To replace the aortic valve. 

Position

•   Supine

•   Catheterization

•   Cleaning and draping.

Anesthesia

General, endotracheal. 

Procedure

   1.  Sternotomy—skin incision with No. 20 blade.

   2.  Saw and cable for sternotomy.

   3.  Pericardiotomy—pericardiotomy with cautery. 

   4.  Pericardial stay 0 1.0 or 2.0 atro silk. 

   5.  Aortic purse string 3.0 T3 single arm suture (2). 

   6.  SVC purse string and cannulation—Cooley clamp, open the SVC insert cannula, remove the clamp, silk tie, connect with venous line. 

   7.  Aaortic cannulation—insert cannula connect the cannula, Bypass on. 

   8.  Cool the patient.

   9.  Aortic cross clamp—No. 11 knife Pott’s for opening the aorta. 

10.  Perfuse left and right coronary. 

11.  Mayo retractor. 

12.  Aortic valve stay 2.0 Ethibond 1/2 pieces. 

13.  Valve is excised. 

14.  Sizer used to measure.

15.  Valve fixed with holder and implanted 2.0 ethibond
17 mm 1/2. 

16.  Closing the aorta 4.0 prolene 3 sutures. 

17.  Cardioplegia cannula for air removal.

18.  Decannulation.

19.  Drainage tubes.

20.  Sponge and instruments count.

21.  Sternotomy closed No. 5 Ethibond.

22.  Muscle 2.0 Vicryl.

23.  Skin 3.0 prolene.

Instruments

•   Cleaning tray 

•   Catheterization set

•   Cardiac set

•   Open heart vascular set

•   Open heart special set

•   Open heart water seal. 

Special Instruments

•   Mayo’s retractor

•   Coronary cannulae (perfusion) 

•   Valve sizer and holder.

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Cardiovascular Surgery Mitral valve replacement

Mitral Valve Replacement (MVR)

Objective

•   To open chest

•   To expose heart

•   To replace the mitral valve.

Position

•   Supine, left semilateral

•   Catheterization

•   Cleaning and draping.

Anesthesia

General, endotracheal.

Procedure

   1.  Sternotomy—skin incision with No. 4 BP handle with No. 20 blade. Rake for holding the skin. Saw and cable for sternotomy.

   2.  Pericardiotomy—pericardiotomy with cautery.

   3.  Pericardial stay 1-0 or 2-0 Atro silk.

   4.  Aortic purse string 3.0 T3 single arm suture (2), followed with snugger and clamped.

   5.  SVC purse string and cannulation—Cooley clamp, scissors for opening the IVC 4/0 CII. S/A followed with snugger and snap.

   6.  Insert IVC cannula, remove the Cooley clamp.

   7.  IVC purse string—4/0 CII, S/A and cannulation—Cooley clamp, open the SVC insert cannula remove the clamp silk tie.

   8.  Aortic cannulation—ready for cannula No. 11 knife for hole in the aorta insert cannula, silk tie; connect the cannula.

   9.  Connect venous lines with SVC and IVC cannula. Aortic cannulae to arterial line.

10.  Cardioplegia purse string and cannulation—cardioplegia cannula, cardioplegia cooling starts.

11.  Aortic cross clamp—after giving cardioplegia the heart stop. 11 No. knife long scissors, open the left atrium, LA retractor, mitral hook. Hang right angle for holding the valve, valve cutting scissors, to excise valve, sizer to measure the valve, take the valve holder and valve, then suture 2.0 Ethibond, LA closure 1st 3.0 Prolene No. 8 Folley’s to check the mitral valve.

12.  Decannulation IVC and SVC cannula taken out and stitched.

13.  Cardioplegia cannula is removed. Aortic cannula is also removed. Aorta stitch 4.0 T3.

14.  Pacing wires—2 pacing wire.

15.  Drainage tubes.

16.  Sponge and instruments count.

17.  Sternotomy closure.

18.  Ethibond.

19.  Muscle

20.  2.0 Vicryl.

21.  Skin 3.0 prolene.

Instruments

•   Cleaning tray

•   Catheterization set

•   Cardiac set

•   Open heart vascular set

•   Open heart special set

•   Open heart water seal.

Special Instruments

•   11 No. knife long handle

•   Nelson scissors

•   Mitral hooks 2

•   Left atrial ret.

•   Long DeBakey needle holder

•   Valve sizers and holder.

Any questions be sent to drmmkapur@gmail.com  

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.com 

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Cardiovascular Surgery Mitral valve Repair

Mitral Valve Repair

Objective

•   To open chest 

•   To repair the mitral valve in mitral regurgitation. 

Position

•   Supine or left lateral 

Anesthesia

General.

Procedure

   1.  Catheterization. 

   2.  Cleaning and draping. 

   3.  Skin incision.

   4.  Saw and cable for mid-sternotomy incision.

   5.  Pericardiotomy and pericardial stay suture 2/0 silk. 

   6.  Aortic purse string 3/0 T3 Tevdek followed by snugger. 

   7.  SVC purse string 4/0 CII followed by snugger IVC cannulae. 

   8.  Aortic cannulation with 11 No blade and aortic cannu­lation, connect the cannulae with arterial line. 

   9.  IVC purse string 4/0 with snugger and IVC cannulae, connect venous cannulae with venous line. 

10.  Cool the patient. 

11.  4/0 T3 Tevdek followed by cardioplegic cannulae.

12.  Aortic cross clamp, open LA with No. 11 long knife with long scissors. LA retractor, hard felt with valve sizer to take size. 9 sutures of 2/0 T3, Tevdek DA to repair the valve with felt. 32 or 36 Portex to check the valve. LA closure 3/0 prolene. 

13.  Decannulation, BP, heart rate, ECG maintained. 

14.  Pacing wires.

15.  Chest drainage tubes.

16.  Control hemostasis. 

17.  Sponge and instruments count.

18.  Sternal closure.

19.  Muscle and subcuticle closure.

20.  Dress with betadine.

Instruments

•   Cleaning tray 

•   Catheterization set 

•   Cardiac set 

•   OH special set 

•   OH vascular set 

•   OH water seal pkt. 

Special Instruments

•   Left atrial set

•   Mitral hooks 

•   11 No. knife long handle 

•   Valve sizers

•   Hard felt.

Any questions be sent to drmmkapur@gmail.com  

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

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Cardiovascular Surgery VSD Correction

Ventricular Septal Defect (VSD)

Objective

•   To open chest 

•   To close a defect (hole) in the ventricular septum. 

Position

•   Supine

Anesthesia

General, endotracheal.

Procedure

   1.  Catheterization. 

   2.  Cleaning and draping. 

   3.  Skin knife No. 3 or 4 BP handle with No. 10 to open the skin, cutting cautery sponge. 

   4.  Saw and cable for opening the sternum. 

   5.  Pericardial; Pericostal stay suture. 

   6.  Loop the SVC and IVC. 

   7.  Aortic purse string IVC and SVC purse string. 

   8.  5.0 Prolene 13 mm or 16 mm double arm, 3/0 T3 or 4/0 T3 sutures snugger, 4/0 T3 suture snugger. 

   9.  Aortic cannulation, scissors and No. 11 knife insert cannula, exhaust with arterial line. 

10.  SVC cannulation, scissors; open SVC, pass the SVC cannula, connect the cannula to venous tubing. 

11.  IVC cannulation clamp, No. 11 knife and scissors. 

12.  Open the IVC, put the IVC cannula, connect the cannula to venous line. 

13.  Cardioplegia purse string and cannulation. 

14.  4/0 T3 single arm Tevdek suture. 

15.  RA stay 4.0 T3 - VSD retractors; VSD suture, 6 to 8 pledget sutures with VSD Decron patch. RA closure 5/0 Prolene.

16.  Pacing wire. 

17.  Open the PA. See PV, PA closure.

18.  PA closed 6/0 prolene.

19.  Remove the cardioplegia cannula. 

20.  Decannulation.

21.  Close the SVC, IVC with 5-0 prolene pieces. 

22.  Remove the aortic cannula; stitch 4.0 T3.

23.  Drainage tube sponge and instruments count. 

24.  Sternum closure after all counts. 

25.  No. 2 ethibond.

26.  Muscle closure No. 3/0 Vicryl. 

27.  Skin 4.0 surgilene.

Instruments

•   Cardiac set 

•   Open heart special set 

•   Open heart vascular set 

•   Open heart water seal 

•   Pediatric set.

Any questions be sent to drmmkapur@gmail.com  

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.com 

www.drmmkapur.blogspot.com                   www.surgseminar.blogspot.com  

Also available now on android & smartphones same internet address